Contributions
Abstract: P693
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS symptoms
Introduction: Between 40-65% of MS patients experience cognitive deficits involving processing speed, attention and working memory (WM). Practical tools, sensitive to detection of early cognitive change, rather than impairment, are critically needed in clinical practice. We hypothesize that a computerized, web-based, serial cognitive test could be a sensitive method to detect change in select cognitive domains and can be used for home self-testing.
Methods: MSReactor is a web-based platform that screens psychomotor (processing) speed, attention and WM. Currently, 450 RRMS participants have completed 6-monthly clinic testing, with the option to complete tasks at home (1-3 monthly). Depression, anxiety and quality of life surveys were completed at each clinic testing session. A subset (n=22) completed the Symbol Digit Modalities Test (SDMT) in the same session.
Results: Most (84.5%) participants opted to complete home-based in addition to clinic-based testing, and 80% of these completed repeat testing within 3 months. Forty (8%) home testing participants reverted to clinic only testing over the follow up period. Participants in the bottom quartile of baseline scores for each task were 50% more likely to revert to clinic only testing (hazard ratio 1.5 (1.1-1.99)) and older participants were 30% more likely to persist with home tests (hazard ratio 0.69 (0.5-0.93)).Test-retest reliability between repeated tests was good for all tasks, following an initial familiarization period (WM test 1-2: ICC 0.66; test 2-3: ICC 0.74; test 3-4: ICC 0.85; test 4-5: ICC 0.88; test 5-6: ICC 0.86). All task scores correlated (p< 0.05) with SDMT scores (r=-0.45, -0.62 and -0.56 respectively). Preliminary change analysis of 116 participants (median follow up 348.5 days) revealed an association between disease duration and quartile with greatest slowing of response time (p< 0.05), independent of therapy use and EDSS. The relationship between therapy use and the worst performing quartile was reassuring in this underpowered preliminary analysis, with non-significant odds ratios less than 1.0.
Conclusion: MSReactor is a reliable and valid tool for monitoring performance in the psychomotor (information) processing, attention and WM cognitive domains. Home-testing persistence is high. Home testing persistence is higher in older and cognitively unimpaired. Early longitudinal data shows that the tests can detect change in 12 months or less and longer duration data will be presented at ECTRIMS.
Disclosure: Daniel Merlo: has received speaker honoraria from Novartis.
David Darby: consultant to Neurability, former founder and shareholder of CogState, CEO of Cerescape, and received honoraria for lectures from Biogen, Novartis and other pharma.
Jodi Haartsen: received grants and assistance from Novartis, Biogen, Genzyme, CSL and Merck.
Tomas Kalincik: served on scientific advisory boards for Roche, Genzyme-Sanofi, Novartis, Merck and Biogen, steering committee for Brain Atrophy Initiative by Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Biogen, Genzyme-Sanofi, Teva, BioCSL and Merck and received research support from Biogen.
Helmut Butzkueven: has received consulting fees from Genzyme, Biogen, Novartis, Merck and Oxford PharmaGenesis and grant/research support from Biogen, Novartis, Merck and Genzyme.
Anneke van der Walt: has received travel support and speakers honoraria from Biogen, Sanofi Genzyme, Novartis, Teva and Merck.
Abstract: P693
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS symptoms
Introduction: Between 40-65% of MS patients experience cognitive deficits involving processing speed, attention and working memory (WM). Practical tools, sensitive to detection of early cognitive change, rather than impairment, are critically needed in clinical practice. We hypothesize that a computerized, web-based, serial cognitive test could be a sensitive method to detect change in select cognitive domains and can be used for home self-testing.
Methods: MSReactor is a web-based platform that screens psychomotor (processing) speed, attention and WM. Currently, 450 RRMS participants have completed 6-monthly clinic testing, with the option to complete tasks at home (1-3 monthly). Depression, anxiety and quality of life surveys were completed at each clinic testing session. A subset (n=22) completed the Symbol Digit Modalities Test (SDMT) in the same session.
Results: Most (84.5%) participants opted to complete home-based in addition to clinic-based testing, and 80% of these completed repeat testing within 3 months. Forty (8%) home testing participants reverted to clinic only testing over the follow up period. Participants in the bottom quartile of baseline scores for each task were 50% more likely to revert to clinic only testing (hazard ratio 1.5 (1.1-1.99)) and older participants were 30% more likely to persist with home tests (hazard ratio 0.69 (0.5-0.93)).Test-retest reliability between repeated tests was good for all tasks, following an initial familiarization period (WM test 1-2: ICC 0.66; test 2-3: ICC 0.74; test 3-4: ICC 0.85; test 4-5: ICC 0.88; test 5-6: ICC 0.86). All task scores correlated (p< 0.05) with SDMT scores (r=-0.45, -0.62 and -0.56 respectively). Preliminary change analysis of 116 participants (median follow up 348.5 days) revealed an association between disease duration and quartile with greatest slowing of response time (p< 0.05), independent of therapy use and EDSS. The relationship between therapy use and the worst performing quartile was reassuring in this underpowered preliminary analysis, with non-significant odds ratios less than 1.0.
Conclusion: MSReactor is a reliable and valid tool for monitoring performance in the psychomotor (information) processing, attention and WM cognitive domains. Home-testing persistence is high. Home testing persistence is higher in older and cognitively unimpaired. Early longitudinal data shows that the tests can detect change in 12 months or less and longer duration data will be presented at ECTRIMS.
Disclosure: Daniel Merlo: has received speaker honoraria from Novartis.
David Darby: consultant to Neurability, former founder and shareholder of CogState, CEO of Cerescape, and received honoraria for lectures from Biogen, Novartis and other pharma.
Jodi Haartsen: received grants and assistance from Novartis, Biogen, Genzyme, CSL and Merck.
Tomas Kalincik: served on scientific advisory boards for Roche, Genzyme-Sanofi, Novartis, Merck and Biogen, steering committee for Brain Atrophy Initiative by Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Biogen, Genzyme-Sanofi, Teva, BioCSL and Merck and received research support from Biogen.
Helmut Butzkueven: has received consulting fees from Genzyme, Biogen, Novartis, Merck and Oxford PharmaGenesis and grant/research support from Biogen, Novartis, Merck and Genzyme.
Anneke van der Walt: has received travel support and speakers honoraria from Biogen, Sanofi Genzyme, Novartis, Teva and Merck.